经后路前后联合减压植骨重建治疗下腰椎A3.3型骨折  

Combined anterior with posterior decompression, bone grafting and reconstruction through posterior approach treat A3.3 lower lumbar fracture

作　　者：任伟剑[1] 项良碧[1] 于海龙[1] 杨会峰[1] 孟令志[1] 刘军[1] 

机构地区：[1]沈阳军区总医院骨科,沈阳110016

出　　处：《中国医学前沿杂志（电子版）》2015年第3期125-129,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的：探讨采用经后路前后联合减压、钛网植骨内固定术治疗下腰椎A3.3型骨折的临床疗效。方法选取本院2005年1月至2011年12月采用经后路前后联合减压、钛网植骨内固定术治疗下腰椎A3.3型骨折患者58例为研究对象，其中L3节段22例，L4节段21例，L5节段15例。以美国脊柱损伤协会（ASIA）标准评估神经功能；通过腰椎X线、腰椎CT评价手术前后、末次随访时Cobb角、椎体前/后缘高度、椎管狭窄率、植骨融合率等；以Charles标准评价临床疗效。结果手术过程顺利，手术时间持续2.4～3.7小时，术中出血量为550～1250 ml。术后发生脑脊液漏3例。所有患者均获18～68个月随访，平均26.4个月；无内固定松动、断裂发生，随访时Cobb角、椎体前/后缘高度、椎管狭窄率较术后无明显变化；随访时植骨融合率满意；术后末次随访神经功能较术前有1～2级恢复。按Charles标准评价临床疗效优良率为89%。结论经后路前后联合减压植骨重建术达到了前后路手术减压效果，具有减压彻底、脊柱三柱即刻稳定、远期矫正率丢失少等优点，是治疗下腰椎A3.3型骨折的有效方法。Objective To evaluate the efifcacy of treating A3.3 lower lumbar fracture by combined anterior with posterior decompression, implantation of titanium mesh and ifxation with pedicle screw through posterior approach. Method From January 2005 to December 2011, 58 patients with A3.3 lower lumbar fracture were treated by combined anterior with posterior decompression, implantation of titanium mesh and fixation with pedicle screw internal ifxation. L3 was involved in 22 cases, L4 in 21 cases, L5 in 15 cases. Neurological status at preoperative, postoperative and ifnal follow-up were reviewed by ASIA scoring system, Cobb angle, inferior and posterior vertebral height, the rate of lumbar stenosis and fusion status were reviewed radiologically. Clinical efifcacy were reviewed by Charles standard. Result The average operation time was （2.9±0.8） hours 2.4~3.7 hours, and the average hemorrhage was 550~1250 ml. Cerebrospinal lfuid leakage occurred in 3 patients, no blood vessel and nerve injury, no infection occurred. The average follow up was 26.4 months （18~68 months）. All patients had complete bony fusion at final follow-up, no looseness and rupture of interna1 fixation, no obvious loss of Cobb angle, inferior and posterior vertebral height and the rate of lumbar stenosis were observed. Nervous function improved in 1~2 degree in all patients. According to Charles assessment, the excellent and good rate was 89%. Conclusion Treatment of A3.3 lower lumbar fracture by combined anterior with posterior decompression, implantation of titanium mesh and ifxation with pedicle screw through posterior approach has the advantages of thorough spinal cord decompression, prompt postoperative three-column stability of spine and less loss of long term correction. It is an ideal operation method for the treatment of A3.3 lower lumbar fractures.

关 键 词：后路 前后联合减压 植骨 钛网 下腰椎骨折 

分 类 号：R687.3[医药卫生—骨科学]